Monthly Archives: July 2012

During the 1970’s I began to hear about “the age of anxiety.” Anxiety disorders have emerged as leading causes of mental and emotional distress today, and are one of the leading motivators for people to seek therapy and medication, as well as being one of the main causes of abuse of alcohol and drugs. Anxiety plays a substantial role in eating disorders, cutting and other forms of self-harm, compulsive disorders, and contributes to overeating and the complications of obesity, such as diabetes. Anxiety contributes to disorders that have a psychosomatic aspect, including cardiac and gastrointestinal disorders. And anxiety underlies a widespread behavior pattern that doesn’t really have a clinical name but has to do with either underperforming, as a way of avoiding the risk of failure or the challenges of success, or overperforming, as a way of trying to extend one’s control over life.

But where does all this anxiety come from? I think that there is a key relationship between anxiety and trust. We have an excess of anxiety, in my opinion, because have a deficiency of trust. This is the first of two columns in which I’ll explore that relationship.

As I often say, it’s no accident that psychotherapy evolved just as Europe was running up to the huge transformations of the first Great War, which led to the redrawing of the global political and socioeconomic map. Psychotherapy, an attempt at a rational approach to understanding unconscious process and healing unconscious rifts, was born more or less at the ending of the great Austro-Hungarian, Ottoman, and Russian empires, with repercussions that are still being felt today, in Europe, the Middle East, Central Asia, and Africa. World War II, a continuation of the first, facilitated the end of the French and English empires, and, reaching to the Far East, led to revolutionary upheavals in the Japanese and Chinese empires, and elsewhere.

Social, political and economic upheaval has affected virtually every family, in ways that are bred into the “DNA,” the behavioral and emotional memes, of family cultures down the generations. To this instability and insecurity are added the vast changes brought about by technological innovations in industry, agriculture, economics, medicine, and communications, which we can see expressed in the culture and even the language of the “new generation” that emerges among adolescents every 5 years or so.

A key result of all this change and transformation has been the loss of trust in the stability of how things are and how things are done; how we communicate, relate, make a living, what we can expect and take for granted. During most of human history, people lived in times when conditions were quite stable, and even the dangers of life were familiar. Things didn’t change much over the generations, let alone during the course of a single lifetime. Indeed, I’m told that, during most of human history, most people lived their entire lives in groups of 30-50 people, to most or all of whom they were related. Those days are gone, for nearly everyone on the planet; although the search for new “tribes” is one of the motivators, and sources of anxiety, in modern life.

It is not only empires that were swept away in the abrupt, tumultuous, often bloody transformations of recent history, but the role and authority of institutions upon which populations depended for stability, including the religious, academic, legal, political, and cultural institutions which where the adhesives that glued the old order together. The resulting psychological challenge of modern life is that we have to learn to trust change rather than stability, which is very hard to do. In order to trust change, we need to understand it better, and to have the roots of our stability anchored in values, relationships and experiences that are deeper than those which are changing.

A key psychoanalytic insight is that the self can dissociate or split into different parts, which may not recognize, or be “unconscious” of one another. It’s also possible to think about a model of mind that is inherently multiple, as in the “Multimind” model described by psychologist Robert Ornstein (http://www.ishkbooks.com/books/MULT3.html), and Human Givens therapist Pat Williams (http://www.humangivens.com/publications/publications/Which-you-are-you-CD.html). In this model, different “selves” come into prominence at different times, rather like actors on a stage; except the director may be absent, and the troupe may be working from an old and fragmentary script. (By the way, it seems to me that the difference between “psychoanalytic” and “psychodynamic” concepts is that psychoanalytic ones postulate a single self that has split, in various ways and for various reasons depending on which analytic theory you buy, while “psychodynamic” concepts can include that as well as multiple self and multiple levels-of-consciousness models of mind.)

Now, here’s where all this comes together. Anxiety is one reason for the evolution of psychotherapy during these revolutionary planetary changes, and anxiety is related to the untrustworthiness of the key institutions upon which we depend for stability and meaning in our lives. It may be that there is a natural process of fragmentation of self, and need for subsequent reunification of self, that is just part of the human condition; the ancient stories certainly indicate that. However, the conditions of modern life encourage fragmentation, without giving much guidance about how to achieve the subsequent unification. It seems to me that that’s where finding the roots of value deep within ourselves, in our relationships with one another and with humanity as a whole, at a deeper level than such transient institutions as government, temple, school, court, etc. can provide, becomes a key part of healing our inner fragmentation and resolving our anxiety.

The old institutions are not entirely irrelevant, of course. They continue to provide a kind of social stichting-together function. In addition, each institution contains, within itself, traditions of access to deeper and higher values. Religions, beyond their role of organizing populations and telling people what to do and believe, included access to spirituality through esoteric and mystical affiliates. Academic institutions, beyond requiring rote learning and preparing students for roles in society, included access to the deeper questions of the meaning of life, especially through philosophy and the humanities (science, a late-comer, is still getting oriented there). Legal institutions, beyond maintaining laws, enshrined devotion to justice, and sometimes exemplified it. Government, in addition to administration, aspires to uplift the well-being of all. Even today, people who feel they can trust their social institutions seem to have less anxiety than others. But sooner or later something happens to undermine their trust, so they do have to deal with being unanchored in life, one way or another. The commitment to the fundamental values of spirituality, meaning, and justice, along with their discernment, seems to have diminished in the practice of religion, education, and law–everywhere, as far as I can tell from what I see around me and glean from newspapers and other media. The result has been that, at a time of great change, when people are in greatest need of connection with perennial human values, the institutions upon which societies have relied to maintain and transmit those values have been less and less up to the job. There are individual justices, reporters, ministers, teachers, administrators, who exemplify highest values, and some organizations do a better job than others of instilling them into the culture. But the institutions, on the whole, are a pretty sorry lot, measured against higher values. They neither embody nor represent such core values, and as a result people are unable to trust them; and, often, one another.

So we can’t trust our social institutions to be what they are supposed to be, and when we ourselves are part of those institutions, we often have to conform, to go along and get along, or else stand against the tide and perhaps get swept away. The resurgence of fundamentalism in religion, and the fundamentalist variant of strict constructionism in legal and judicial practice, seem to me to reflect the misguided attempt to return to the times when the institutions of religion and law were more closely connected to spirituality and justice, respectively. However, that’s like focusing on the utensils we ate with years ago, because we are hungry now. As to education for meaning in life, our academic institutions seem to have pretty much given up on it, except for those which go in for brainwashing, and the odd teachers and schools here and there who persist in trying to help students connect with themes of meaning in life, albeit against the tide of rote learning for high stakes testing, indoctrination in social beliefs, and education for vocational preparation. The attempt by departments of education across the country to develop a common core curriculum (see my post of April 16th, 2012), is an attempt to establish fundamentals in education, but it focuses on behavioral objectives that can be measured, so it must, of necessity, omit the crucial dimension of meaning of life and connection with the real core values of experience. And so, in the midst of our busy lives, we are adrift.

As a psychotherapist, I find that issues of spirituality, meaning and justice in life (expressed through family and other personal relationships, as well as relationships with teachers, employers and other institutions) often underlie anxiety, although that is not something you will find in the professional literature, such as the DSM-IV (http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders). As the great psychologist Abraham Maslow pointed out, when these issues are identified and clients are able to make progress by establishing or reestablishing their connections with their own spirituality, sense of meaning, and love of justice (what Maslow called the “being-values”), anxiety tends to diminish. But that is not taught in our therapist training programs today either, since it can’t be reduced to a measurable behavioral objective.

(Reviewed by Delores S. Doherty, MD, FRCPC, St. John’s Newfoundland, in the Journal of the Canadian Academy of Child and Adolescent Psychiatry, 2006, 15, 95-6)

This book could not have come into my experience at a better time. My patients are growing up, and lo and behold, they are still disabled!

Hanging by a Twig is the way one disabled adult described her life, i.e., just hanging on and always precariously. Mary’s story is told in chapter 2, intermingled with information on the historical context of our current understanding of learning disabilities, learning styles, cognitive strengths and weaknesses. Each chapter in this book is built around the story of an adult with specific learning issues. Carol Wren moves us through the stated purpose of the chapter while Jay Einhorn gives us a psychotherapeutic commentary on the issues described. Together they take us through development of self, coherence of self, adult skill set, self-esteem, addiction, and other co-morbidities, looking at the issue and its impact on the individual.

The pervasive nature of these impairments of cognition on the overall functioning of the individual becomes very evident as we read these real life stories. In addition, the challenges for doing therapy with these people, who are intrinsically at heightened risk for personality distortions, jumps from the pages. The authors make clear the need to help these adults understand their own strengths and limitations. Then they are better able to make informed choices in regard to further education and career, to seek appropriate supports for themselves, and to begin to consider the impact of their disabilities might make on personal relationships.

As a group involved with children and adolescents, I believe that we also have an obligation to attempt to help our adult colleagues understand that these individuals suffer.

This book is a resource that we can recommend with enthusiasm. It is well written and provides clear descriptions of a number of possible scenarios as well as suggestions for management. I will be encouraging those I know who counsel adults with residual developmental concerns to read and learn from Hanging by a Twig. I have already recommended it to our local chapter of the Learning Disabilities Association. It is an excellent resource and an enjoyable reading experience.